经阴道超声检查对盆腔深部浸润型子宫内膜异位症诊断价值的分析

目的 评价经阴道超声(TVS)检查对宫骶韧带、直肠阴道膈、子宫直肠陷凹和直肠乙状结肠深部浸润型子宫内膜异位症(DIE)诊断的准确性。资料与方法 系统检索关于TVS诊断DIE中英文文献,根据诊断性实验准确性质量评价工具(QUADAS)评价文献质量,采用Meta-disc1.4软件对不同部位DIE的灵敏度、特异度、阳性似然比(+LR)、阴性似然比(-LR)及诊断性试验比值比(DOR)等进行Meta分析及异质性检验,对无异质性文献绘制综合受试者工作特征(SROC)曲线。结果 纳入文献23篇。TVS诊断宫骶韧带、直肠阴道膈、子宫直肠陷凹及直肠乙状结肠DIE灵敏度为0.78(95%CI,0.68-0.86)、0.55(95%CI,0.42-0.67)、0.89(95%CI,0.80-0.94)、0.86(95%CI,0.74-0.93)；特异度为0.92(95%CI,0.88-0.94)、0.98(95%CI,0.95-0.99)、0.96(95%CI,0.83-0.99)和0.94(95%CI,0.90-0.97)；+LR为9.3(95%CI,6.9-12.5)、26.9(95%CI,11.6-62.0)、24.5(95%CI,4.8-123.9)和14.9(95%CI,7.7-28.9)；-LR为0.24(95%CI,0.15-0.36)、0.46(95%CI,0.36-0.61)、0.11(95%CI,0.06-0.20)和0.15(95%CI,0.07-0.29)；DOR为40(95%CI,24- 66)、58(95%CI,24-141)、219(95%CI,46-1043)和102(95%CI,29-360)。四个部位SROC曲线下面积分别为0.94(95%CI,0.91- 0.95)、0.88(95%CI,0.85- 0.91)、0.96(95%CI,0.94-0.98)、0.97(95%CI,0.95-0.98)。结论 TVS对宫骶韧带、直肠阴道膈、子宫直肠陷凹、直肠乙状结肠DIE的整体诊断性能良好、特异性高,可作为DIE常规的诊断手段。

Analysis of Diagnostic Value of Transvaginal Ultrasonography in Deep Infiltration Endometriosis of Pelvic Cavity

Objective To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in detecting endometriosis in uterosacral ligament, rectovaginal diaphragm, pouch of Douglas and rectosigmoid colon before operation. Materials and Methods The literature about TVS diagnosis of deep invasive endometriosis (DIE) was systematically searched, including Chinese and English. The literature quality was evaluated according to QUADAS, and then the sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic odds ratio (DOR) of different parts of endometriosis were evaluated by Meta-disc1.4 software. Results Totally 23 literatures were enrolled. The sensitivity of TVS in diagnosing uterosacral ligament, rectovaginal diaphragm, pouch of Douglas and rectosigmoid DIE was 0.78 (95%CI, 0.68-0.86), 0.55 (95%CI, 0.42-0.67), 0.89 (95%CI, 0.80-0.94) and 0.86 (95%CI, 0.74-0.93); The specificity was 0.92 (95%CI, 0.88-0.94), 0.98 (95%CI, 0.95-0.99), 0.96 (95%CI, 0.83-0.99) and 0.94 (95%CI, 0.90-0.97); +LR is 9.3 (95%CI, 6.9-12.5), 26.9 (95%CI, 11.6-62.0), 24.5 (95%CI, 4.8-123.9) and 14.9 (95%CI, 7.7-28.9); -LR is 0.24 (95%CI, 0.15-0.36), 0.46 (95%CI, 0.36-0.61), 0.11 (95%CI, 0.06-0.20) and 0.15 (95%CI, 0.07-0.29); DOR is 40 (95%CI, 24-66), 58 (95%CI, 24-141), 219 (95%CI, 46-1043) and 102 (95%CI, 29-360). The areas under SROC curve of four parts are 0.94 (95%CI, 0.91- 0.95), 0.88 (95%CI, 0.85- 0.91), 0.96 (95%CI, 0.94-0.98) and 0.97 (95%CI, 0.95-0.98) respectively. Conclusion The overall diagnostic performance of TVS for uterosacral ligament, rectovaginal diaphragm, pouch of Douglas, and rectosigmoid colon DIE is good and specific, and can be used as a routine diagnostic method for DIE.